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. 2023 Mar 16;16(4):e011408. doi: 10.1161/CIRCEP.122.011408

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© 2023 The Authors.

Circulation: Arrhythmia and Electrophysiology is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.

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Figure 5. — Flowchart of the procedure for intracardiac echocardiography (ICE)–guided left bundle branch pacing (LBBP). *Confirm LBB capture with accepted pacing parameters: (1) pace the morphology of the right bundle branch block pattern; (2) record the LBB potential from the LBBP lead; (3) stimulus-peak left ventricular (LV) activation time (LVAT) shortens abruptly with increasing output and remains the shortest and constant at low and high outputs. †The method of adjustment of the pacing lead position involves the following aspects: (1) the pacing lead helix was closer to the endocardium of the LV monitored using ICE, (2) the pacing lead is positioned perpendicular to the IVS and enters the endocardium of the LV, as monitored using ICE, (3) under ICE guidance, the pacing lead was kept away from the scar area of the IVS. (4) The LBBP lead was implanted around the original site under the guidance of ICE. APM indicates anterior papillary muscle; RA, right atrium; RV, right ventricular; and TA, tricuspid annulus.